Please let us know if you find these handouts and forms helpful. If you have any feedback on these forms, or suggestions for additional handouts or forms, please contact us at: 1-877-824-3463 or email Debbie Hilton Kamm at info@caheartconnection.org. We are always looking for additional information that can help those with heart defects.

Compiled list of information critical to those with children with CHD. Includes information on medical issues to clarify with the physician, helpful products, Early Intervention services, insurance/financial information, and much more. This Guide is an invaluable tool for physicians, case managers and parents of children with CHD.

Information every parent should have available in case of emergency with space to fill in important information. Copies can be distributed to caregivers, school administrators, and kept in the car or other areas in case of emergency.

Form to be filled out by physician which delineates which symptoms warrant a call to the doctor, or a trip to the ER. Helps to decrease parent's anxiety trying to determine the severity of a medical issue and gives them clear instructions for specific symptoms.

Overwhelmed parents may be confused as to the many different follow-up and other appointments that are necessary. This form allows physicians to fill in approximate timelines for future appointments, vaccinations, therapies, etc. which helps parents keep current with important medical appointments.

Benefits and possible side effects of many common pediatric heart medications, with fill-in area for physicians to indicate dosage information and special instructions such as what to do if a dose is missed, storage information and more. Medication summaries courtesy of PedHeart Prints Patient Education Software, developed by Scientific Software Solutions.

Families are often confused about the function of each of the different medical specialists they come in contact with. This form includes a description of different medical specialties and appropriate questions to ask each specialist. Space is provided to include contact information for each for referrals.

A simple form for teachers, substitutes, and others to know the major issues your child has, and what actions should be taken. Includes a confidentiality waiver so the information can be distributed to other parents or aides as needed.

Sample 504 Plan- A sample 504 plan that can be used as a guideline to bring up issues with school administrators to create appropriate accommodations for your child.

Form to clarify appropriate activities for the child with CHD. Excellent tool for clarification for parents, care-givers and schools so that the patient's health is not compromised, and the child is not excluded from activities that are not dangerous.

Below you will find a description of each of the forms available. All forms are downloadable for free.

Customize materials by entering your office contact information in the top right-hand corner.

Fill out forms with personalized information for each patient. When using Acrobat 8, form data can be saved record-keeping for each patient, or to share with other physicians, such as the patient's pediatrician.

Print materials for patient.

Parenst/Patients:

Download and print the following handouts and forms that are applicable for you.

Take the printed forms to your physician to be filled out so that you have a clear understanding and record of any medical instructions. This is especially important to communicated clearly with schools and other caregivers.